Class note for JTA course

1. WoundWound ClosingClosing
( Suture and Suturing( Suture and Suturing
techniques)techniques)
Ishwor Dhakal
Animal Health I

2. 2 Principles of Wound Management
Wound ClosureWound Closure
Primary closure
– Suture, staple, adhesive, or tape
– Performed on recently sustained lacerations: <12
hours generally and <24 hours on face
Secondary closure
– Secondary intent
– Allowed to granulate
Tertiary closure
– Delayed primary (observed for 4-5 days)

3. 3 Principles of Wound Management
Suture MaterialSuture Material
Absorbable
o Natural: Catgut-plain or chromic
o Synthetic: Polyglactin (vicryl), polyglycolic acid
(dexon)
Non-Absorbable
Natural: Silk linen
Synthetic: Polyamide (nylon), polyester
(dacron), polypropylene (prolene)
Monofilament vs. braided

4. 4 Principles of Wound Management
CHARACTERISTICS OF ANCHARACTERISTICS OF AN
IDEAL SUTUREIDEAL SUTURE
Ideal suture material should:
1. Have good handling characteristics
2. Not induce significant tissue reaction
3. Allow secure knots
4. Have adequate tensile strength
5. Not cut through tissue
6. Be sterile
7. Be non-electrolytic
8. Be non-allergenic
9. Cheap

5. 5 Principles of Wound Management
Surgical gutSurgical gut
These sutures are derived from naturally
occurring purified connective tissue (mostly
collagen) of the small intestine of sheep or cattle.

6. 6 Principles of Wound Management
SUTURING TECHNIQUESSUTURING TECHNIQUES
Good suturing technique should
eliminate dead space in
subcutaneous tissues, minimize
tension that causes wound
separation.

7. 7 Principles of Wound Management
Wound ClosureWound Closure
Undermine the wound edges
– Release tension

8. 8 Principles of Wound Management
Suture TechniquesSuture Techniques
Deep layer
approximation
– Absorbable sutures
– Buried knot
– Serves two purposes
Closes potential
spaces
Minimizes tension on
the wound margins

9. 9 Principles of Wound Management
Skin ClosureSkin Closure
Key – wound edge eversion
“Approximate, don’t strangulate”
Anticipate wound edema
Choose appropriate size of suture for
location of laceration

10. 10 Principles of Wound Management
Suture TechniquesSuture Techniques
Simple Interrupted
– Used on majority of wounds
– Each stitch is independent

11. 11 Principles of Wound Management
Suture TechniquesSuture Techniques
Simple Continuous
– Useful in pediatrics
Rapid
Easy removal
– Provides effective hemostasis
– Distributed tension evenly along length
– Can also be locked with each stitch

12. 12 Principles of Wound Management
Suture TechniquesSuture Techniques
Horizontal Mattress
– Useful for single-layer closure of lacerations
under tension

13. 13 Principles of Wound Management
Horizontal MattressHorizontal Mattress

14. 14 Principles of Wound Management
Suture TechniquesSuture Techniques
Vertical Mattress
– Useful for everting skin edges
– “Far-far-near-near”

15. 15 Principles of Wound Management
Vertical MattressVertical Mattress

16. 16 Principles of Wound Management
Suture TechniquesSuture Techniques
Purse-string
– Useful for stellate lacerations

17. 17 Principles of Wound Management
Suture TechniquesSuture Techniques
Instrument tie

18. 18 Principles of Wound Management
Wound CareWound Care
Dressing
– Maintain dry for 24-48 hours
– Use antibiotic to maintain moist environment
– If overlying a joint, splint in a position of
function
– Sun protection to prevent scar
hyperpigmentation
– Suture removal instructions!

19. 19 Principles of Wound Management
Figure :
Techniques
of needle
holding
and
suturing

20. 20 Principles of Wound Management
Figure :
Different
types of
needles

21. 21 Principles of Wound Management
Figure :
Techniques
of tying
knot

22. 22 Principles of Wound Management
Figure :
Simple
interrupted
suturing
technique

23. 23 Principles of Wound Management
Figure :
‘Flask-like
configuratio
n’ of simple
interrupted
suturing
technique

24. 24 Principles of Wound Management
Figure : Vertical mattress suturing
technique

25. 25 Principles of Wound Management
Figure : Near . far vertical mattress
suturing technique

26. 26 Principles of Wound Management
Figure : Horizontal mattress suturing
technique

27. 27 Principles of Wound Management
Figure : Running suturing technique

28. 28 Principles of Wound Management
Figure : Running horizontal mattress
suturing technique

29. 29 Principles of Wound Management
Figure : Running subcutaneous
suturing technique

30. 30 Principles of Wound Management
Figure : Running subcuticular
suturing technique

31. 31 Principles of Wound Management
SUTURE REMOVALSUTURE REMOVAL
Sutures should be removed at the
earliest possible
time to prevent or minimize suture
reaction and suture marks but they
should remain in place long enough
to prevent wound dehiscence and
scar spread.

32. 32 Principles of Wound Management
SUTURE MATERIALSUTURE MATERIAL
SELECTIONSELECTION
When choosing a suture material, it is
important to consider
o the location of wound,
o static and Dynamic wound tension
o presence of wound infection or fever
o and cost of suture material.
If fever or chance of infection is high,
then deep sutures composed of synthetic
monofilament sutures are desirable

33. 33 Principles of Wound Management
Practice Time!Practice Time!